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OU T <br /> MONITORING WEL.' INSTALLA'IION REP,.,xsT <br /> T <br /> yS3-z 4 <br /> Date: CONSTRUCTION <br /> Premise Address: 5/0 o Total Depth `%s <br /> Screen Length (from) -21 y ' (to) YS— <br /> Well No.: Filter Pack (from) IS (to) cis <br /> Bentonite (from) Ar (to) - <br /> Inspector: " d Grout (from) /6 ' (to) c <br /> Drilling rig type <br /> Permit No. Auger O.D. k% I.D. N 1/> <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: e r <br /> Driller: _ x /_��u * casing <br /> I <br /> eight <br /> Consultant_ �.,.,%� G✓a,- ,ea.� J ♦ 7 h <br /> Geologist ✓l i/ c.J�%s <br /> A3CVEwRCUN0 C} ISTY-8CX <br /> CrMP��TCN C.^.i41P!=�iCN <br /> SPECIAL PERMIT INFO. G=nd Sul-we <br /> Distance to sewer line grat <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n_ <br /> _ � e <br /> SAMPLING wG s <br /> 1-e c./u s s ���u`lc� tiactad = c <br /> lc� �G Sid ru A4, ioctcn <br /> Holding Temperature �w l_ 72V'W pack <br /> Method 11 <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) <br /> IL <br /> SPOILS <br /> Storage Method SS �;u� �vu r�-�s Soleef MATERIALS/DEVELOPMENT <br /> Contamination Noted - C y�a v S� ming type pvc -Yo �a <br /> Storage Location /�✓es �c.�� Sc�� <br /> Blank ft. Screen, ds— <br /> Slot size <br /> GROUTING Bags cement -5— <br /> Buckets <br /> Buckets bentonite <br /> Depth to water 97 Bags sand/gravel 2"i(z <br /> Mix Ratios7 c>' �r Filter Pack ype/size <br /> Installation Method Surge Block: - C y/�) <br /> Quantity Installed Discussed with geologist. - (Q n ) <br /> Type of method <br /> FH 29 29 <br />